Professional Ethics

then, the object was to deal immediately with current hurts as detected, and to plan for the needs of the communities in the future. I am not familiar with the "too many investigations by outsiders" to which Miss Warmington refers. All medical and health providers at Fitzroy Crossing at the time of the audit had had limited experience of the area, and were certainly not in a position to advise Miss Warmington. Community Health Services is particularly mindful of any action or programme that might result in a loss of rapport with Aboriginal communities. Being charged with the administration of the medical audit at Fitzroy Crossing, I was especially careful not to damage my relationship with the Aboriginal communities that had evolved with 10 years' work in the region. With regard to the principle of informed consent, I am unsure what this means for a sophisticated white community, let alone an Aboriginal community. The method that I followed in Fitzroy Crossing was to talk to communities in general terms about the objectives of the medical audit, then to personally conduct leaders of individual enclaves through the audit cycle. With this experience, the Aboriginal leaders in consultation with other members of the gerontocracy then made the decision as to whether those persons that they were responsible for should attend the medical audit. The response was such that I can only conclude that given the chance Aboriginal persons tend to be health risk avoiders. It interested me also that those white persons who were most vocal against such an exercise for Aboriginal persons also attended for examination at the medical audit. I saw no anger expressed by Aboriginal elders about "round-ups" as is alleged by Miss Warmington. Billy indeed told me of some event, deep in his memory, of genital inspection and examination which apparently involved the police force. What Billy is saying if he is listened to carefully is that the black fellow is the same as the white man now, and that that event in his past when, as he says it, "they did naughty things to us", was not going to happen anymore because white man is the same as black man now. He was seeking assurance that what had apparently been done then, in public, was not going to occur again to him. In fact Billy, on being taken through the medical audit, was more than satisfied with the arrangements. "Very good thing for us," as he puts it.

then, the object was to deal immediately with current hurts as detected, and to plan for the needs of the communities in the future.
I am not familiar with the "too many investigations by outsiders" to which Miss Warmington refers. All medical and health providers at Fitzroy Crossing at the time of the audit had had limited experience of the area, and were certainly not in a position to advise Miss Warmington.
Community Health Services is particularly mindful of any action or programme that might result in a loss of rapport with Aboriginal communities.
Being charged with the administration of the medical audit at Fitzroy Crossing, I was especially careful not to damage my relationship with the Aboriginal communities that had evolved with 10 years' work in the region. With regard to the principle of informed consent, I am unsure what this means for a sophisticated white community, let alone an Aboriginal community. The method that I followed in Fitzroy Crossing was to talk to communities in general terms about the objectives of the medical audit, then to personally conduct leaders of individual enclaves through the audit cycle. With this experience, the Aboriginal leaders in consultation with other members of the gerontocracy then made the decision as to whether those persons that they were responsible for should attend the medical audit. The response was such that I can only conclude that given the chance Aboriginal persons tend to be health risk avoiders. It interested me also that those white persons who were most vocal against such an exercise for Aboriginal persons also attended for examination at the medical audit.
I saw no anger expressed by Aboriginal elders about "round-ups" as is alleged by Miss Warmington. Billy indeed told me of some event, deep in his memory, of genital inspection and examination which apparently involved the police force.
What Billy is saying if he is listened to carefully is that the black fellow is the same as the white man now, and that that event in his past when, as he says it, "they did naughty things to us", was not going to happen anymore because white man is the same as black man now. He was seeking assurance that what had apparently been done then, in public, was not going to occur again to him. In fact Billy, on being taken through the medical audit, was more than satisfied with the arrangements. "Very good thing for us," as he puts it. SIR: In reply to Dr Spargo's letter: I make no apology for writing as a brief visitor to the area, as I believe there is potential for a useful appraisal of such situations by one not directly involved. In fact, I did meet Dr Spargo, at the briefing for the European community at Fitzroy Crossing, held two days before the beginning of the audit. Although the local health workers, through their intimate relationships with the Aboriginal community, allowed me to meet the people on a closer level than most visitors, they did not advise me in the expression of my own opinions.
As I understand it, no thorough explanation of the audit to the level of the Aboriginal people's understanding (the sense in which I use the words "informed consent") was attempted by the organizers before the circus began. I would suggest that the conversation with Billy Briant described by Dr Spargo occurred after the first few days of the audit, when the dwindling attendance and elders' angry meeting convinced those persons administering the event that reassurance and explanation would be needed if their aims were to be realized. SALLY WARMINGTON. 301 Barkers Road, Kew, Vic. 3101.
[We do not question either Dr Spargo's sincerity or Miss Warmington's sincerity, but this appears to us to be an excellent example of how the same set of circumstances may appear rather differently according to the angle of the observer.-EDITOR.] FOOD ALLERGY SIR: appreciate the concern and sceptrcrsrn of Dr Burns and Dr Bryant' regarding the possibility of a method other than diet to diagnose and treat food allergy. The crux of the basic problem, however, is whether the success of sublingual milk therapy in my patient with symptoms due to milk sensitivity represents a serendipity or a fact." This patient is not an isolated case, but is representative of many I have seen and treated using these methods during the past three years.
A hearsay report." and poorly designed larger studies" 5 published in abbreviated form do not negate the methods I employed or my findings. By present-day definition an allergy should be explained in immunological terms. My patients had classical allergic symptoms, as well as other complaints compatible with the allergic-tensionfatigue syndrome. The immune system is so complex that it is not possible to arbitrarily compartmentalize the human body into areas which can or cannot respond to offending foods, or other allergenic items. The fact, established by repeated trials, that the patient's diverse symptoms were relieved when he avoided all milk or after he received milk extract therapy, does not currently have an immunological explanation. This is not to say that one will not be found when more is known. There is no doubt, also, that drugs such as nitroglycerine are absorbed sublingually. Why not foods? By dietary challenge at five-day intervals, I repeatedly proved that my patient was sensitive to milk. By skin-testing I repeatedly produced and eliminated symptoms in the presence of impartial observers. On double-blind challenge on three occasions the patient could differentiate milk from placebo-filled capsules. Twice, he differentiated milk treatment extract, once from one placebo and once from two placebo solutions.
My attempts to determine an immunological mechanism were unsuccessful, but this in no way negates my observations. An inability to explain a scientifically validated finding does not mean that the observation is incorrect. Rather, the explanation of scientifically sound observations provides a pathway to focus research efforts and develop new hypotheses. This has been the pattern of successful medical advance through the centuries. This patient is not a medical anecdote, but a scientifically documented clinical study, in which repeated blind milk challenges were followed by predictable results which were carefully documented to be dose-related. Some day our information banks will explain why this patient responded favourably. My hope is that interested scientists and clinicians will accept the challenge to reproduce and explain these careful observations and those of others who have published similar double-blind documentation." 7 The recent study by Buisseret may provide an initial step, in that his work showed that changes in prostaglandin levels can be produced in food-sensitive patients who do not have Ig E antibodies to specific offending foods." DORIS J. RAPP. 1405 Colvin Boulevarde, Buffalo, N.Y. 14223. Orr is not precise about where he believes I was wrong, but I gather his complaint is that I did not properly reflect his purpose in writing the letter.
My reply to this is that my interest as a journalist in the letter was more in a part than the whole. To illustrate my position: if a physicist had written a report on nuclear reactor construction and had revealed there was a problem containing leaks at a local reactor, I would be more interested in this JULY 29, 1978 than in his thesis in general. With Dr Orr's letter, arguing that it was proper at times for a doctor to interfere in the management of another doctor's case, my interest lay mainly in his recital of a number of serious mistakes he knew to have been perpetrated by colleagues. Here was a professional expose of medical blunders. It seemed to me that the public, which may suspect such errors but cannot prove them, was entitled to hear these allegations from an authoritative source. I did not ignore that the letter was part of an ethical debate, but the account of the errors was necessarily paramount in my report, as indeed I think it was in the letter.
Dr Orr asked that his name not be used when I telephoned him about his letter, but Herald news executives decided not to depart from the normal practice of naming correspondents to the Journal, in the same way as we name authors of papers. As a result of our conversation I did emphasize prominently that the errors described had occurred over more than 30 years, a point not made in Dr Orr's letter. I also reported that Dr Orr said none of the incidents mentioned represented current standards of practice, another qualification missing from the letter. I also avoided one of his stronger statements: " The frightening examples I have listed are only the tip of the DP.38/DG iceberg and those that spring readily to mind". I appreciate that Dr Orr did not expect his criticism to go beyond the Journal. But the Journal is made available to the media without prohibition and it is obviously my job to cull from it matter that is properly a topic for public information and discussion. SHAUN McILRAITH. 235-243 Jones Street, Broadway, N.S.W. 2007.